Cyclospora: Seasonal nuisance or preventable problem?

Unfortunately, every summer we experience Cyclospora outbreaks almost as routinely as hurricane season. That’s unfortunate because, at some point, we need to stop viewing these outbreaks as expected, unavoidable seasonal events and start treating them as preventable incidents. 

Just like hurricane tracking, projections, and building standards have improved over time, so too should capabilities in regard to Cyclospora surveillance, detection and prevention. 

But to do so more effectively, important scientific and research gaps remain that must be addressed to better understand, investigate and prevent Cyclospora illnesses. For example, just because a particular fresh produce vehicle hasn’t been previously linked to illnesses doesn’t mean it can’t be involved. We also need to better understand the role of weather, environmental conditions, and a variety of water sources, along with more detailed insights into the attribution of various routes of potential exposure to the parasite.

But we don’t have to wait for more research to take action – we can act now based on what we already know.

For illnesses definitively attributed to food, enhanced prevention will likely require stronger, seasonally aware sourcing practices, improved agricultural water quality, and strengthened food safety measures throughout, but especially early, in the fresh produce supply chain.

The current situation also highlights why Cyclospora outbreaks are so difficult to solve. The parasite’s long incubation period makes it challenging for investigators to identify exposures. Molecular subtyping capabilities continue to improve but require further advancement. Traceback investigations back to the source remain difficult, particularly as implementation of the FDA’s Food Traceability Rule has been extended. In addition, when food related, the suspect vehicle is often a “stealth ingredient” that may be incorporated into a variety of foods or menu items, making it difficult for ill individuals to recall.

While state and local public health agencies do an outstanding job, and we are all grateful for their efforts, this outbreak also underscores the need to further support and strengthen federal coordination of foodborne outbreak investigations and response. 

For example, the Cyclospora case counts reported by news outlets based on state data indicates more than 2,000 cases, while CDC data has yet to catch up. The CDC is reporting just 145 cases through June 16, and FDA has reported they’re investigating only two small outbreaks totaling 10 illnesses. 

Moreover, public messaging has differed across jurisdictions. Clearly, this discrepancy must be confusing to consumers. 

It also highlights the need for more timely and transparent reporting, along with stronger federal-state coordination and action.

This is one reason I have previously advocated for the creation of a National Foodborne Outbreak Investigation Board, modeled after the National Transportation Safety Board (NTSB), to strengthen coordination, improve transparency, and accelerate the identification of lessons learned following major foodborne outbreaks.

Let’s hope that the growing number of illnesses reported across multiple states enables investigators to quickly identify the – source or sources – of these illnesses, so that we can prevent additional people from becoming ill.

And let’s work together to continue to invest in and further modernize our food safety and public health systems. American consumers deserve no less.